丹参治疗骨内高压实验研究

目的：寻找中药对ＬｅｇｇＰｅｒｔｈｅｓ病及各种骨性关节炎等伴有骨内高压症的治疗方法并研究其机理。方法：将骨内高压动物模型随机分为相等的治疗组和对照组,分别肌肉注射等量的丹参注射液和生理盐水,然后测双侧骨内压并取固定侧胫骨近端骨块制作扫描电镜标本观察。结果：发现治疗组双侧骨内压比较无差异０２０＞Ｐ＞０１０,固定侧骨髓超微结构近似正常;对照组固定侧骨内压明显高于正常侧Ｐ＜０００１,固定侧骨髓超微结构明显处于病理状态。结论：丹参具有治疗骨内高压的显著作用,其机理为改善了骨内高压下的骨髓微循环病理状态。     

骨内高压与退行性膝关节病关系的临床研究

目的　探讨骨内高压在退行性膝关节病发病中的作用。方法　对 6 4例退行性膝关节病患者行膝部骨内压测定及加强试验。结果　退变膝骨内压高于正常膝 (P<0 .0 1) ;休息痛膝的骨内压明显高于无痛膝 (P<0 .0 1)和活动痛膝 (P<0 .0 5) ;活动痛膝与无痛膝比较无显著差别 ,但前者加强试验阳性率明显高于后者 (P<0 .0 0 1)。结论　退行性膝关节病存在骨内压增高 ;骨内压与退变膝的疼痛密切相关     

丹参预防骨内高压实验研究

丹参预防骨内高压实验研究刘福云许振华＊⒇师红近年来国内外学者对Ｐｅｒｔｈｅｓ病，顽固性跟痛症，膝关节骨性关节炎等进行研究，发现这些疾病与骨内高压密切相关〔１～３〕。因此，寻找预防骨内高压的方法和药物，成为当前研究的热门课题。丹参是活血化瘀，调节血...     

牵引顶压及骨愈散外敷治疗腰椎间盘突出症265例

观察牵引膝部后方顶压旋转复位加按摩及中药骨愈散外敷治疗法治疗腰突症效果。方法：牵引膝部后方顶压旋转复位加按摩及中药骨愈散外敷治疗法治疗腰突症265例，并经1～10年随访。结果：治疗265例，治愈236例（89．06％），显效18例（6．79％），好转6例（2．26％），无效5例（1．89％）．未发现任何并发症。结论：牵引膝部后方顶压旋转复位加按摩及中药骨愈散外敷治疗法治疗腰突症．具有显著的疗效。     

骨内高压症的研究现状和进展

自骨内压的概念被提出以来,对骨内压的研究一直是骨科学基础与临床研究的一个重要部分。目前已经证实,许多骨科疾病的发生、发展与转归,都与骨内压的改变关系密切。现就骨内压的研究现状综述如下。1骨内压及其骨内高压症的基本概念骨内压又称骨髓内压或骨髓压,在1938年由Larsen     

蝮蛇抗栓酶对骨内高压降压作用实验研究

本实验随机将家兔一侧后肢于膝关节伸直位夹板外固定５周，制成固定侧胫骨上端骨内高压模型。对其全身和局部血液流变学指标进行测定，发现全血粘度，血浆粘度增大，血沉增快，血浆纤维蛋白原含量明显增高。对上述模型应用蝮蛇抗栓酶（ｓｖａｔｅ）连续治疗２１天，骨内压降低，血液流变学各项指标亦降低。本实验结果显示，蝮蛇抗栓酶通过改善骨内高压状态下的异常血液流变学状态可使骨内高压降低，从而认为血液流变学疗法可能成为临床治疗骨内高压症的一种新手段，而蝮蛇抗栓酶可能为其中高效药物之一。     

膝部疼痛与骨内压关系的临床研究

作者对５０例膝疼痛患者进行了双侧膝关节Ｘ线检查、膝部骨内压测定以及止血带加压试验。休息痛膝的髌骨、股骨远端和胫骨近端骨内压平均值分别为４．５１ｋＰａ、４．１５ｋＰａ和３．５４ｋＰａ，无痛膝（对照组）三个部位骨内压平均值分别为２．７５ｋＰａ、３．０７ｋＰａ和２．８４ｋＰａ。休息痛膝的膝部骨内压均明显高于无痛膝（Ｐ值＜０．０２）。止血带加压试验休息痛膝阳性率为９２．７％，活动痛膝阳性率为２１．４％，无痛膝均阴性。骨内压增高、休息痛和止血带加压试验阳性三者呈一致性关系。经皮骨穿刺术是治疗膝关节休息痛的简单、有效的方法。     

膝部复杂骨折的内固定治疗

目的：探讨膝部复杂骨折的治疗方法。提出内固定分级。方法：自1994-1999年收治膝部复杂骨折43例。经切开复位，应用多种内固定器材分级内固定42例。结果：经6个月-5年随访优良率80.1%。结论：认为采用切开复位分级内固定方法适于膝部复杂骨折。强调术后早期功能锻炼及CPM应用，作者提出内固定分级对术前及术后治疗方案制定有一定的参考价值。     

正常与骨内高压下骨髓微循环冷冻割断扫描电镜观察

目的 探讨骨内高压症的发病机理。方法 随机取正常家兔１６只,测量双侧胫骨近端骨内压,证明两侧压力值对比差异无显著性意义。再取家兔４０只,用塑料夹板等将其一侧后肢于膝关节伸直位固定５周,制成骨内高压动物模型,死亡１４只,取其中１４例行双侧胫骨近端骨内压测量,证明固定侧骨内压值显著高于另（对照）侧。随机取骨内高压模型家兔１２只,同时随机取正常家兔６只,对其双侧胫骨近端骨髓微循环及造血组织进行二甲基亚砜     

椎弓根螺钉复位内固定、椎间植骨融合治疗腰椎滑脱症

目的探讨椎弓根螺钉复位内固定、椎间植骨融合治疗腰椎滑脱症的疗效。方法对42例腰椎滑脱症患者采用椎弓根螺钉复位内固定、椎间植骨融合术,通过随访进行疗效评定。结果42例随访6-40个月,参照海涌等临床疗效评估标准：优23例,良14例,可5例。所有患者椎体间植骨均融合良好,复位无丢失。内固定未见松动、断裂。结论椎弓根螺钉复位内固定、椎间植骨融合术治疗腰椎滑脱症,临床效果满意,植骨融合率高,是一种治疗腰椎滑脱症较为理想的术式。     

胫、股骨内压与膝关节疼痛关系的研究和治疗方法探讨

作者对膝关节痛和休息痛的病人21例测量了股、胫骨内压和关节镜检查,其均值股骨髁0.143±0.011kpa,16例(76.19％)超过对照组0.130kpa(P<0.01);胫骨髁0.180±0.022kpa,18例(85.7％),超过对照组0.105kpa。同时测量膝关节腔内压21例,均值为0.135±0.035kpa,18例(85.7％),高于对照组0.120kpa。认为骨内压增高是引起膝关节痛的原因之一。     

Intraosseous hypertension and pain in the knee.

The intraosseous pressure in the femur and tibia near the knee and in the internal saphenous vein at knee level was measured in fifty-three patients with suspected knee lesions. There were four groups: with and without degenerative osteoarthritis and with and without aching rest pain of the knee region. Low intraosseous pressures were found in patients with neither osteoarthritis nor rest pain, and in half the patients with osteoarthritis but without rest pain. Low pressures were found in the tibia, but very high intraosseous pressures were found in the femur in most patients with osteoarthritis and rest pain. Patients with no osteoarthritis but with rest pain mostly had high pressures in both the tibia and the femur.     

A new concept in the treatment of anterior knee pain: patellar hypertension syndrome

This prospective clinical study evaluated 69 patients (136 knees) presenting with anterior knee pain after failure to respond to conservative treatment. All patients agreed to undergo minimally invasive intraosseous pressure measurements of the patella under local anesthesia. Forty patients (50 knees) demonstrated a positive pain provocation test (the typical pain sensation could be reproduced by raising intrapatellar pressure) and were treated with a new method of intraosseous drilling and decompression. Ninety percent of the patients treated experienced pain relief >3 years postoperatively. Repeated intraosseous pressure measurements in 33 knees 1 year postoperatively confirmed objective intraosseous pressure reduction in 88%. Patients with anterior knee pain and a positive pain provocation test were labeled as hypertension syndrome of the patella. These results indicate simple extra-articular patellar decompression may offer a valuable new form of treatment in select patients with anterior knee pain, ie, hypertension syndrome of the patella.     

Patellar hypertension syndrome in adolescence: a three-year follow up

Introduction Anterior knee pain is one of the major causes of knee pain in an adolescent population. It has been suggested that raised intraosseous pressure may play an important role in the development of anterior knee pain in the young patient.Material and methods A prospective clinical multicentre study with 27 adolescent patients presenting with anterior knee pain was performed. After failure to respond to conservative treatment, all patients agreed to undergo minimally invasive intraosseous pressure measurements in local anaesthesia. All 27 patients demonstrated a positive "pain provocation test" as a response to increased intrapatellar pressure and were decompressed with a new intraosseous drilling technique.Results The repeat intraosseous pressure measurement in 27 patients 1 year postoperatively revealed a significant reduction from 43.3±13.4 preoperatively to 24.1±4.2 mmHg (p<0.001). The pain relief was documented in the form of a reduced VAS from 7.6±1.4 to 2.1±1.1 cm after 3 years (p<0.001).Conclusion Patients with anterior knee pain and a positive "pain provocation test" were diagnosed as suffering from a hypertension syndrome of the patella. We conclude that simple extraarticular patellar decompression may offer a valuable new form of treatment in this select group of adolescent patients with anterior knee pain.     

Changes of articular cartilage after immobilization in a rat knee contracture model

The objective was to determine the changes of articular cartilage of the knee joint during immobilization in a rat model. The knee joints of adult male rats were immobilized at 150° of flexion using an internal fixator for 3 days, and 1, 2, 4, 8, and 16 weeks. The articular cartilage from the medial midcondylar region of the knee was obtained, divided into three areas (non‐contact area, transitional area, contact area), and in each area, a degree of degeneration was evaluated by gross observation, histomorphometric grading, and measurements of thickness and number of chondrocytes. Elasticity of the articular cartilage was estimated by measuring the sound speed with use of scanning acoustic microscopy. Degeneration of the articular cartilage was mainly observed in the contact and transitional areas. Matrix staining intensity by safranin‐O and number of chondrocytes were decreased in these two areas. The thickness of the articular cartilage in the non‐contact and contact areas was unchanged, but it was increased in the transitional area. Decrease in sound speed was observed in the transitional area of both the femoral and tibial cartilage, indicating the softening of the articular cartilage. The changes of articular cartilage became obvious as early as 1 week after immobilization. These changes may be due to a lack of mechanical stress or a lack of joint fluid circulation during immobilization. Although we do not know the reversibility of these changes of articular cartilage, early mobilization is preferable to avoid these cartilage changes. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:236–242, 2009     

胫骨平台下截骨关节清扫治疗退行性膝关节病

目的：退行性膝关节病,为一累及大多数老年人而治疗棘手的疾患,保守治疗效果欠佳,故设计骨平台下截骨、关节清扫的外科手术方法,以取得较好的疗效。方法：（1）从胫骨前内台,骨板线以下,做伸向前、外、后三个方向之薄层楔形截骨,继从平台关节面,在厚垫保护下向下锤击嵌合截骨线,从内上斜向外下交叉2枚钢针固定。（2）切除髌股关节为主,以及上下骨关节边缘增生骨赘、清除关节游离体、变性并继将脱落软骨面,切除变性滑膜。（2）就近取骨膜做缺失软骨面贴付或缝合移植。结果：21例病人,经平均6．7年随访,优良率占90．6％,效果较满意,无加重影响功能的并发症。结论：胫骨平台下眉状截骨、关节清扫、骨膜移植修复软骨面的方法,为一治疗退行性膝关节病可行的外科治疗手段;认为设计构思合理,利于加宽关节间隙、骨内减压、恢复关节光整面,以促进关节功能恢复。     

川芎对骨内高压状态下血液流变学的影响

３３只家兔随机分为三组：正常组、对照组和治疗组，后两组均将家兔一侧后肢于膝关节伸直位持续固定５周，制成该侧胫骨上端骨内高压模型，另侧不固定作为对照侧，分别应用生理盐水和２０％川芎注射液治疗３周，测定双侧胫骨上端骨髓血和颈静脉血血液流变学指标：全血粘度、血浆粘度、血沉、血浆纤维蛋白原、红细胞压积。结果２０％川芎注射液治疗３周后，其血液流变学指标除红细胞压积外均恢复正常，与正常组比较差异无显著性（Ｐ＞０．０５），而与生理盐水组比较则差异有显著性（Ｐ＜０．０５）；且骨髓血与静脉血的血液流变学改变基本一致。说明川芎注射液能改善骨内高压下血液流变学异常状态，从而降低骨内高压。